使用光学相干断层扫描血管造影术观察和治疗糖尿病性黄斑水肿时，对黄斑无血管区变化的可视化。

Visualization of changes in the foveal avascular zone in both observed and treated diabetic macular edema using optical coherence tomography angiography.

作者信息

Gill Aditya, Cole Emily D, Novais Eduardo A, Louzada Ricardo N, de Carlo Talisa, Duker Jay S, Waheed Nadia K, Baumal Caroline R, Witkin Andre J

机构信息

New England Eye Center, Tufts Medical Center, Tufts University, 800 Washington Street, Box 450, Boston, MA 02111 USA.

Department of Electrical Engineering and Computer Science, and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, MA 02139 USA.

出版信息

Int J Retina Vitreous. 2017 Jun 19;3:19. doi: 10.1186/s40942-017-0074-y. eCollection 2017.

BACKGROUND

Central vision loss in diabetic retinopathy is commonly related to diabetic macular edema (DME). The objective of this study was to describe changes between consecutive visits on optical coherence tomography angiography (OCTA) of the foveal avascular zone (FAZ) in eyes with DME.

METHODS

20 eyes from 14 patients with DME were imaged on 2 successive clinic visits separated by at least 1 month. The mean interval between visits was 3.2 months. The only intervention used was intravitreal anti-VEGF in 11 eyes; the others were observed over time without treatment. Two different readers measured FAZ area using a pseudo-automated tool in comparison to a manual tracing tool. Qualitative changes in the appearance of the vasculature surrounding the FAZ were also recorded. The retinal capillary plexus was segmented into deep and superficial plexuses, and FAZ measurements were done on the superficial, deep, and summated plexuses.

RESULTS

Pseudo-automated and manual measurements of FAZ area decreased significantly ( < 0.05) between visits in the deep, superficial, and summated plexuses. Qualitative analysis of vasculature surrounding the FAZ showed that most of the vascular changes (65%) over time were visible in the deep plexus, compared to 30 and 20% in the superficial and summated plexuses, respectively.

CONCLUSIONS

The most significant differences in FAZ size over time were in the summated plexus ( < 0.001), while changes in FAZ appearance were most prominent in the deep plexus. Absolute decrease in FAZ size over visits was largest in the deep plexus. Our results demonstrate that OCTA can effectively be used to measure FAZ area in patients with DME, visualize qualitative changes in retinal vasculature, and visualize the segmentation levels at which these changes can be best appreciated. However, larger studies are needed to evaluate the reproducibility of manual and pseudo-automated measuring techniques.

背景

糖尿病性视网膜病变中的中心视力丧失通常与糖尿病性黄斑水肿（DME）有关。本研究的目的是描述DME患者黄斑无血管区（FAZ）在连续光学相干断层扫描血管造影（OCTA）检查之间的变化。

方法

14例DME患者的20只眼睛在至少间隔1个月的2次连续门诊就诊时进行成像。就诊之间的平均间隔为3.2个月。仅11只眼睛采用玻璃体内抗VEGF治疗；其他眼睛未治疗，随时间观察。两名不同的阅片者使用伪自动化工具并与手动追踪工具比较来测量FAZ面积。还记录了FAZ周围血管外观的定性变化。视网膜毛细血管丛被分为深层和浅层丛，并在浅层、深层和总和丛上进行FAZ测量。

结果

在深层、浅层和总和丛中，就诊之间FAZ面积的伪自动化和手动测量均显著减小（<0.05）。对FAZ周围血管的定性分析表明，随着时间推移，大多数血管变化（65%）在深层丛中可见，而在浅层和总和丛中分别为30%和20%。

结论

随着时间推移，FAZ大小最显著的差异出现在总和丛中（<0.001），而FAZ外观变化在深层丛中最为突出。就诊期间FAZ大小的绝对减小在深层丛中最大。我们的结果表明，OCTA可有效用于测量DME患者的FAZ面积，可视化视网膜血管的定性变化，并可视化能最好观察到这些变化的分割水平。然而，需要更大规模的研究来评估手动和伪自动化测量技术的可重复性。